Brand New Day Program from HMO California

(a Medicare Advantage Special Needs Plan for persons disabled by chronic mental illness)

Pharmacy Quality Dispensing Bonus Program

In an effort to improve medication compliance for HMO California members with Poly Pharmacy, HMO California is putting in to place a program to encourage its pharmacy providers to furnish poly pharmacy members their medications in bubble packs and have the medication delivered to the member’s residence.

Incentive

For all HMO California members with poly pharmacy, pharmacies will be paid $2.50 per medication up to $15.00 per month per member when the prescription is provided in a bubble package, and delivered to the member’s residence.

Please use form below:

Pharmacy Name:
Pharcacy Tax ID:
Pharmacy Street Address:
City:
State:	Zip:
Pharmacy Fax No.:	E-mail:
Member's Name:
Member Date of Birth:
Member ID:
Date of Fill:
Medications were provided in bubble package and delivered to members residence:	YesNo
Number of medications filled: